Enter record of accomplishments on attached form or retype questions.

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1 North Carolina 4-H Community Service Program. Sponsored by: NC 4-H Honor Club Purpose: The 4-H Community Service Program encourages 4-H groups to become involved in improving their communities by solving problems through action projects based on the following method: $ Develop relationships with community leaders. $ Identify and consider community problems. $ Make a plan of action. $ Carry out the plan. $ Take a look back and ahead. $ To develop a group unity in a successful community group project. $ To develop leadership responsibility while carrying out a project. Objectives: $ 4-H group to: $ Learn the importance of group action to accomplish results beyond the reach of any one individual. $ Develop a concern for the community and its people. $ Provide information to help people become aware of a problem and gain public commitment for action. Suggestions for participating groups: Any organized 4-H group is eligible to participate. Enter record of accomplishments on attached form or retype questions. Submit completed report form to local Extension 4-H Agents at time designated by them. Due to State 4-H Office by March 1. Attach to the report form supporting materials such as news clipping, pictures, flyers to further tell the story of your work. A Guide for Extension Agents and Volunteer Leaders to Use in Planning with 4-H Groups. Choose a project that is within the capabilities of the group and one that benefits the community as a whole. Please refer to the section attached entitled APlanning Community Service Learning Activities@.

2 BASIS FOR SCORING 4-H GROUP AWARDS PROGRAM Teamwork Experience (50%) Ability of group to identify a problem and develop a plan of action Ability of group to involve members and leaders within group in implementing plan of action Ability of group to involve others individuals and groups and utilize community facilities in implementing plan of action Individual Member=s Experience (25%) New knowledge, attitudes and skills acquired Project and activity participation experience Experience in learning to be a team member Contribution and Service to Group and Community (25%) Resulting group and community awareness of program emphasis Resulting group, family and community action Resulting group, family and community betterment TOTAL (100%)

3 Report on 4-H Community Service Project To be completed by 4-H club or group and submitted to County Extension 4-H Agents. NAME OF CLUB OR GROUP COUNTY NUMBER OF 4-H MEMBERS: TOTAL 1. Name or title of Community Service Project/Program 2. Number of meetings or work sessions in which program being reported was included: 3. What were the goals and outcomes of your project/program. 4. What was your Plan of Action

4 5. How did your group identify community needs or problems? 6. What project/activities did your group conduct? Tell how many people were involved and what type of task assignments, working committees were used and what type of training plan did you use. 7. What sort of time line did you use in planning/implementing this community service project. 8. How did you plan for obstacles that may have occurred in your project. List your communication plan. Describe cooperation with other community organizations, agencies, individuals, and groups. 9. How did you budget for this project? 10. What major changes were accomplished due to the result of your involvement in this Community Service Project/Program. A: To your 4-H Group?

5 B: To your Community? 11. What are your plans for continuing this program? 12. What sort of evaluation did you use to evaluate your program/project? 13. Have 4-H=ers collectively tell what they learned through this service project this year. COUNTY 4-H OFFICE: Receive and prepare all reports for judging. Provide certificates for all participating groups. Submit county=s one best entry to State 4-H Office by March 1 of each year. AWARD: SPONSORED BY NC 4-H HONOR CLUB County: Certificates will be presented to all 4-H Clubs or groups conducting a 4-H Community Service Project/Program. District: Certificates will be presented to District Winners. State:1st Place - $150.00, 2 nd Place - $100.00, 3 rd Place - $50.00 All State Winners will receive a certificate Signature of Volunteer Leader Signature of 4-H Agent Date: